Minors Lack the Autonomy to Consent to Gender-Affirming Care: Best Interests Must Be Primary.

What ethically justifies the provision of invasive and irreversible treatments to minors? In this commentary, I examine this question in response to Moti Gorin's article "What Is the Aim of Pediatric 'Gender-Affirming' Care?," which critiques autonomy-based arguments for justification of gender-affirming care in minors. Minors generally lack sufficient autonomy to make significant medical decisions or major life decisions. For this reason, parents are generally their decision-makers, working with medical professionals to choose treatments that serve the best interests of the minor. Medical care in minors is justified by beneficence, not autonomy, and this should be no different for gender-affirming care. This severely undermines autonomy-based arguments for provision of gender-affirming care to minors. Given the lack of conclusive evidence for benefit, the nature of the treatment, and the fact that gender dysphoria in minors resolves spontaneously in most cases, there is presently insufficient justification for provision of such care to minors.

Children's voices on their participation and best interests during a hospital stay in Australia.

PURPOSE: To explore school-aged children's experiences about their best interests and participation in care during a hospital admission. DESIGN AND METHODS: A descriptive qualitative design involving in-depth, iterative inductive review of child responses to generate key words that led to identification of categories and themes. The study was guided by the United Nations Convention on the Rights of the Child's definition of the best interests of the child, Bronfenbrenner's bioecological model and a child centred care approach. RESULTS: Nine school-aged children (5-15 years old) from one children's ward in Australia participated. Analysis yielded thirteen categories, six sub-themes, and three themes: 1) Relationships with parents were positive when they met their children's physical and emotional needs and advocated for them; 2) Relationships with staff were positive when staff created opportunities for children to have a say in their healthcare, and checked in on the children and 3) Seeking familiarity away from home was facilitated when the environment children found themselves in provided them their own space and various forms of entertainment. CONCLUSION: School-aged children were able to verbalize what their best interests were and how participation in care could be facilitated in the hospital setting. The inter-relationships of the children with their parents, healthcare professionals, and the immediate environment reflected interactions both within, and between systems. RESEARCH AND PRACTICE IMPLICATIONS: Children in hospital need to be provided with age-appropriate opportunities to participate in shared decision making to support their best interests. Studies that model and evaluate such opportunities are needed.

Attachment goes to court: child protection and custody issues.

Attachment theory and research are drawn upon in many applied settings, including family courts, but misunderstandings are widespread and sometimes result in misapplications. The aim of this consensus statement is, therefore, to enhance understanding, counter misinformation, and steer family-court utilisation of attachment theory in a supportive, evidence-based direction, especially with regard to child protection and child custody decision-making. The article is divided into two parts. In the first, we address problems related to the use of attachment theory and research in family courts, and discuss reasons for these problems. To this end, we examine family court applications of attachment theory in the current context of the best-interest-of-the-child standard, discuss misunderstandings regarding attachment theory, and identify factors that have hindered accurate implementation. In the second part, we provide recommendations for the application of attachment theory and research. To this end, we set out three attachment principles: the child's need for familiar, non-abusive caregivers; the value of continuity of good-enough care; and the benefits of networks of attachment relationships. We also discuss the suitability of assessments of attachment quality and caregiving behaviour to inform family court decision-making. We conclude that assessments of caregiver behaviour should take center stage. Although there is dissensus among us regarding the use of assessments of attachment quality to inform child custody and child-protection decisions, such assessments are currently most suitable for targeting and directing supportive interventions. Finally, we provide directions to guide future interdisciplinary research collaboration.

Public health nurses' encounters with undocumented migrant mothers and children.

OBJECTIVES: Undocumented migrant children (UMC) are often affected by policies and practices that do not take their best interests into account. The aim of this study was to describe how public health nurses (PHNs) experienced challenges and dilemmas in ensuring the best interests of the undocumented migrant child. DESIGN: This study had a qualitative descriptive design. SAMPLE: Focus group interviews and semi-structured interviews were conducted with seven PHNs in four different child health centers (CHCs). RESULTS: Qualitative content analysis was applied. Three main themes were identified: building trust, ensuring the best interests of the child, and dilemmas and challenges in ensuring the best interests of the child. The study revealed examples of immigration policy being prioritized over the best interests of the child. PHNs experienced frustration when the best interests of the child were not taken into account. Strategies for managing these conflicting demands were identified. CONCLUSION: Conflicting demands appeared when national immigration policies collided with fundamental human rights and ethical standards. Rules that exclude certain groups are incompatible with PHNs professional ethics.

New York State Creates New Governance of Commercial Gestational Surrogacy.

United States law recognizes adult reproductive liberty and many states view surrogacy services through that lens. During the COVID-19 pandemic in March, 2020, New York State enacted the Child-Parent Surrogacy Act (CPSA) into law, after feminists and their allies had caused its defeat in 2019. Just before approval of the CPSA, a group of legislators introduced the Alternative Surrogacy Bill (ASB). This article is a case study that examines how the CPSA and not the ASB became law, examining surrogate rights, the best interests of the child, and the ethical issues related to adult donor-conceived and surrogacy born children's rights to information about their ancestry.

TOWARDS CREATION OF UNIFIED REGULATION ON SURROGACY IN EUROPE: RECENT TRENDS AND FUTURE PERSPECTIVES.

OBJECTIVE: The aim of this paper is to study the existing international legal framework, regulating international surrogacy agreements and to analyse the possibility of adoption of respective unified European legal instrument. PATIENTS AND METHODS: Materials and methods: The article is based on international legal acts, jurisprudence of the European Court of Human Rights, reports and scientific articles. The research is grounded on dialectical, formal logical methods, methods of synthesis and analysis, comparative legal method and the method of modelling. CONCLUSION: Conclusions: The authors came to conclusion about the necessity of introducing of unified legal instrument dealing with international surrogacy cases. The article illustrates that the work towards harmonization of surrogacy in Europe started at the beginning of 21st century and the experts group of the Hague Conference on Private International Law is currently working on drafting a respective protocol. The authors provide a list of questions that were not noticed by the mentioned experts but should be included in the protocol.

The Best Interests of the Child from Different Cultural Perspectives: Factors Influencing Judgements of the Quality of Child-Rearing Environment and Construct Validity of the Best Interests of the Child-Questionnaire (BIC-Q) in Kosovo and Albania.

Child-rearing practices and beliefs of what determines a 'good quality' of child-rearing differ across cultural contexts and more than one interpretation can be given to "a child's best interests". This study aims to examine the cultural factors that influence judgements of the quality of children's rearing environment, and the construct validity of the Best Interests of the Child-Questionnaire (BIC-Q) scale when used in the Western Balkans. In our research on migrant children who returned to Kosovo and Albania, the BIC-Q is used to assess the quality of the child-rearing environment from a local cultural perspective on child-rearing. To assess cultural differences in judgements of the child-rearing environment, we measured agreement through Cohen's kappa of BIC-Qs completed from a Western-Balkan and a Western-European perspective on child-rearing. The construct validity of the BIC-Q scale was assessed through a Mokken scale analysis. The findings show that - except for two items - there is substantial agreement between Western-European and Western-Balkan assessors regarding the direction of the judgement, i.e. if the scores on the child-rearing conditions are dichotomized (sufficient/insufficient). The judgements of the 'respect' and 'interest' conditions are sensitive to differences in the cultural or professional perspectives of the assessors. The findings of the Mokken scale analysis demonstrate a strong and reliable scale in the cultural context of the Western Balkans (H = .73; Rho = .97). Knowledge gained from using the BIC-Q to assess the living situation of returned migrant children in their countries of origin and insight into child-rearing standards provides input for the best interests of the child determination.

MAINTAINING THE LEGAL STATUS OF PEOPLE WITH INTELLECTUAL DISABILITIES AS PARENTS: THE ADA AND THE CRPD.

People with intellectual disabilities face proceedings to terminate their parental rights with disturbing regularity, with protecting the interests of offspring the primary justification. Although protecting children from harm is surely critical, these termination proceedings involve problematic assumptions about how fitness to parent is understood, how parenting is legally constructed, and what nondiscrimination requires for parents with intellectual disabilities. Using Article 12 of the Convention on the Rights of Persons with Disabilities as a model, it suggests two alternatives to the all-or-nothing termination processes in place today that might better realize the enjoyment of legal capacity as parents on an equal basis with others for people with intellectual disabilities: limited terminations analogous to limited guardianships and supported parenting along the lines of supported decision making proposed in the CRPD.

Recently arrived refugee children: The quality and outcomes of Best Interests of the Child assessments.

Best Interests of the Child (BIC) assessments provide migration authorities with behavioral information about which interests of the child could be taken into account before a decision is made on the request for a residence permit. This study provides insight into the quality and outcomes of BIC assessments with 16 unaccompanied children (15-18 years) and 11 accompanied children (4-16 years) who have recently arrived in the Netherlands and requested asylum (N = 27). The results suggest that BIC assessments provide relevant information that enables assessors to determine the best interests of recently arrived refugee children. The inter-rater reliability of the BIC-Questionnaire, an instrument that evaluates the child-rearing environment and that is one of the components of the BIC assessment, was fairly good. The children in the sample had experienced a high number of stressful life events and a majority reported trauma related stress symptoms or other emotional problems. The quality of the child-rearing environment in the country of origin had protected their development insufficiently in the past and would not protect their development sufficiently in the future. The results show that in many cases forced return to the country of origin can put children's development at risk.

Safeguarding child rights and enhancing caregiver responsibilities among Canadian parents of youth who sexually offend.

Research on youth sexual offending has focused primarily on its prevalence. However, recent efforts have begun to consider the collateral consequences for the relatives of offending youth, although little has been done in this regard toward exploring caregiver accountability. This study presents qualitative data on parents' sense of responsibility in situations where their child engaged in sexual offending behaviour against another child. We analyzed interview data among 16 parents from 10 families in Canada using thematic coding procedures. Findings illustrated the range of responsible actions that caregivers of sexual offending youth undertook with regard to preventing recidivism and accessing appropriate services for all the abuse-affected children. Caregivers reported on the enormous complexities they encountered as they attempted to simultaneously attend to the best interests of both the victim and offending youth. A particularly significant theme was that, despite the overwhelming challenges caregivers faced in dealing with the needs of their offending child, they were also highly attentive to the well-being of the victims. Our findings point to the importance of comprehensive and non-biased support services for both children and caregivers in order to fully uphold the rights of all affected individuals, and to better meet the needs as well as best interests of sexual abuse-affected children.

Beyond an Open Future.

Discussions about the ethical permissibility of pediatric cognitive enhancement frequently revolve around arguments about welfare, and often include an appeal to the child's right to an open future. Both proponents and opponents of cognitive enhancement claim that their respective positions best serve the interests of the child by promoting an open future. This article argues that this right to an open future argument only captures some of the risks to the welfare of children, therefore requiring a broader ethical approach. Further, it suggests that a thorough moral assessment of the ends pursued is needed before concluding on the moral permissibility of cognitive enhancement in children, which ultimately hinges on the effect on the overall welfare of the child, beyond an open future.

A Defensoria Pública e Cuidados em uma Relação de Cuidado: Um Estudo de Caso / The Public Defender in a Care Relationship: a Case Study / La Defensa Pública en una Relación de Cuidado: un Estudio de Caso

Resumo A Defensoria Pública ocupa lugar em processos judiciais de destituição do poder familiar atuando majoritariamente em favor dos pais de famílias pobres. O psicólogo na Defensoria que atua em processos judiciais é chamado de assistente técnico. O objetivo do presente artigo é discutir concepções pertinentes à atuação do psicólogo na Defensoria a partir do lugar processual do assistente técnico, especialmente compreendido dentro das políticas públicas que trabalham com famílias necessitadas nos termos da lei. Para tanto, foi feito um estudo de caso com pesquisa documental qualitativa em busca das ações radicais possíveis. Os dados e as ações foram pensados à luz das teorias winnicottianas do desenvolvimento e do conceito de juízes anexos, de Foucault. O discurso dominante na Psicologia mantém a lógica de legislações anteriores ao Estatuto da Criança e do Adolescente, em que se culpabiliza a família pobre em processos de destituição do poder familiar. O assistente técnico figurou como importante ator para a inserção, no sistema de justiça, da compreensão de que um bebê não é um bebê sozinho, mas será sempre acompanhado de seus principais cuidadores, pessoas de quem ele depende e que são sujeitos que pretendem desfrutar de uma sociedade livre. A prática comunitária produziu o efeito de criar soluções para a situação que gerou sofrimento aos membros de uma família. Concluímos que teorias que associam pobreza e incapacidade de cuidar dos filhos funcionam de modo similar aos códigos minoristas anteriores ao Estatuto da Criança e do Adolescente...(AU)

Abstract The Public Defender takes place in lawsuits of destitution of the family power acting largely in favor of the parents of poor families. The psychologist at Public Defender that acts in legal proceedings is called technical assistant. The purpose of this article is to discuss pertinent concepts to the psychologist’s activities in Public Defender from the procedural place of the technical assistant, especially understood within the public policies that work with needy families in accordance with law. To that end, we made a case study with qualitative documental research searching for possible radical actions. The data and actions were thought in the light of Winnicott’s development theories and the concept of attachments judges, by Foucault. The dominant discourse in psychology maintains the logic of previous legislation to the Statute of Children and Adolescents, in which blames the poor family in the family power dismissal processes. The technical assistant figured as an important actor for the inclusion, in the justice system, of the understanding that a baby is not a baby alone, but will always be accompanied by their primary caregivers, people he depends and which are subject wishing to enjoy a free society. The community practice had the effect of creating solutions to the situation that caused suffering to family members. We conclude that theories linking poverty and inability to take care of the children, they work in a similar way as minorists codes previous to Child and Adolescent Statute....(AU)

Resumen La Defensa Pública tiene lugar en la destitución del poder familiar actuando en gran medida a favor de los padres de familias pobres. El psicólogo de la Defensa Pública que actúa en los procedimientos legales se llama asistente técnico. El propósito de este artículo es discutir los conceptos pertinentes para la accíon del psicólogo en la Defensa Pública desde el lugar de asistente técnico, entendido sobre todo dentro de las políticas públicas que trabajan con las familias necesitadas de conformidad com la ley. A tal efecto, se realizó un estudio de caso con la investigación cualitativa documental en busca de posibles acciones radicales. Los datos y las acciones fueron diseñados a la luz de las teorías de desarrollo de Winnicott y el concepto de los jueces adjuntos, de Foucault. El discurso dominante en psicología mantiene la lógica de la legislación anterior en el Estatuto de los Niños y Adolescentes, en el que culpa a la familia pobre en los procesos de despido de alimentación de la familia. El asistente técnico hay figurado como un actor importante para la inclusión, en el sistema de justicia, de la comprensión que un bebé no es un bebé solo, pero siempre estará acompañado por sus cuidadores primarios, la gente que depende y que están deseando sujetos a disfrutar una sociedad libre. La práctica comunitaria produjo el efecto de crear soluciones a la situación que causó sufrimiento a los familiares. Llegamos a la conclusión de que las teorías que vinculan la pobreza y la incapacidad para cuidar de los niños trabajan de una manera similar a los códigos anteriores minoritas el Estatuto de los Niños y Adolescentes....(AU)

Knowledge of the Unknown Child: A Systematic Review of the Elements of the Best Interests of the Child Assessment for Recently Arrived Refugee Children.

Decision-making regarding an asylum request of a minor requires decision-makers to determine the best interests of the child when the minor is relatively unknown. This article presents a systematic review of the existing knowledge of the situation of recently arrived refugee children in the host country. This research is based on the General Comment No. 14 of UN Committee on the Rights of the Child. It shows the importance of knowing the type and number of stressful life events a refugee child has experienced before arrival, as well as the duration and severity of these events. The most common mental health problems children face upon arrival in the host country are PTSD, depression and various anxiety disorders. The results identify the relevant elements of the best interests of the child assessment, including implications for procedural safeguards, which should promote a child rights-based decision in the asylum procedure.

OUTSOURCING ETHICAL DILEMMAS: REGULATING INTERNATIONAL SURROGACY ARRANGEMENTS.

This article argues that the English legislative regime is ineffective in regulating international surrogacy, particularly with regard to commercial payments. It suggests that if English law views surrogacy as exploitative, we have a responsibility to protect women both in England and abroad, and the only way to do so effectively is to create a domestic system of regulation that caters adequately for the demand in this country. This requires a system of authorisation for surrogacy before it is undertaken; ex-post facto examinations of agreements completed in other jurisdictions, after the child is already living with the commissioning parents, cannot be seen as an acceptable compromise, as authorisation will inevitably be granted in the child's best interests.

Interés superior de los niños y niñas: Definición y contenido / The best interests of the child: Definition and content / Interesse superior de meninos e meninas: Definição e conteúdo

El presente artículo es de tipo analítico y es fruto de una revisión constante de la literatura y la jurisprudencia relacionadas con el principio de interés superior de los niños y niñas. El interés superior de los niños y niñas, tanto en la doctrina como en la jurisprudencia, ha sido objeto de múltiples definiciones, pero con muy poco contenido. Con el presente trabajo destaco tres elementos ineludibles del interés superior de los niños y niñas que se deben hacer valer en cada caso concreto, siendo estos: la manifestación del sujeto menor, su entorno, y la predictibilidad. Con estos tres elementos, al analizarlos y encuadrarlos en cada caso concreto, se podría ofrecer una mejor decisión y una mejor explicación al Interés superior de los niños y niñas.

This article is analytic and is the result of a consistent review of the literature and case law concerning the principle of the best interests of the child. The best interests of the child, both in doctrine and case law, has been redefined over time, but with very little content included these definitions. This article highlights three essential elements of the principle of the best interests of the child that should be applied in each case: the child’s wishes, their environment and the predictablity of their circumstances. Identifying and analyzing these three elements in each concrete case can lead to better decisions being made as well as a better explanation of the best interests of the child principle.

Este artigo é analítico e é resultado de uma ampla revisão da literatura e jurisprudência sobre o princípio do interesse superior da criança. Os interesses da criança, tanto na doutrina e na jurisprudência, passou por várias definições, mas com muito pouco conteúdo. Neste artigo destacam-se três elementos irrefutáveis de interesse superior da criança que devem se fazer valer em cada caso concreto, sendo estes: a manifestação do sujeio menor, seu ambiente e previsibilidade. Com estes três elementos, ao analisá-los e enquadrá-los em um caso particular, que poderia proporcionar uma mehor ducisão e uma melhor explicação para os melhores interesses da criança.